Daniel S. Kirschenbaum

Obese people who seek treatment have different characteristics than those who do not seek treatment.

A group of obese people who had not sought treatment, an obese group who had sought treatment in a professional, hospital-based program, and normal-weight controls (N = 547) were compared in regard to level of psychopathology, binge eating, and negative emotional eating. Because the groups differed significantly on several demographic variables, 3 demographically matched groups were created and compared (n = 177, 59 per group). In the matched subgroups, obese people who had sought treatment reported greater psychopathology and more binge eating than did those who had not sought treatment or did normal-weight controls. Both obese groups (including those who had not sought treatment) endorsed more symptoms of distress, negative emotional eating, overeating, difficulty resisting temptation, and less exercise than did normal-weight controls.

Self-monitoring may be necessary for successful weight control

The relationship between self-monitoring and weight control was examined closely by analyzing 18 weeks of data for 56 participants in a long-term cognitive behavioral weight-loss program. The percentage of subjects who monitored consistently, which monitoring variables were most related to weight change, and the effect of variability in monitoring on weight change were examined. Approximately 2/3 of the subjects monitored food consumption for the entire day more than half of the days; approximately 1/4 did not monitor on most days. Monitoring—any food eaten, all foods eaten, time food was eaten, quantity of food eaten, and grams of fat consumed—was positively correlated with weight change. Not monitoring at all was negatively associated with weight change. More consistent monitors lost more weight and participants lost much more weight during their best, compared to their worst, weeks of monitoring. These results support the notions that self-monitoring, and perhaps “obsessive-compulsive self-regulation,” are necessary for successful weight control.

How can obese weight controllers minimize weight gain during the high risk holiday season? By self-monitoring very consistently.

This study examined the efficacy of augmenting standard weekly cognitive-behavioral treatment for obesity with a self-monitoring intervention during the high risk holiday season. Fifty-seven participants in a long-term cognitive-behavioral treatment program were randomly assigned to self-monitoring intervention or comparison groups. During 2 holiday weeks (Christmas-New Years), the intervention groups treatment was supplemented with additional phone calls and daily mailings, all focused on self-monitoring. As hypothesized, the intervention group self-monitored more consistently and managed their weight better than the comparison group during the holidays. However, both groups struggled with weight management throughout the holidays. These findings support the critical role of self-monitoring in weight control and demonstrate the benefits of a low-cost intervention for assisting weight controllers during the holidays.

Bulimia: Assessment of eating, psychological adjustment, and familial characteristics

The eating attitudes and behavior, psychological functioning, and family dynamics of 25 women with bulimia (binge-purge syndrome) were examined by comparing their responses on self-report measures to those of a normal control group. As expected, the bulimic clients displayed many more problems in their eating attitudes and behavior and a disturbingly high level of behavioral-emotion distress. Responses to the family assessment measures suggested possible familial factors that may contribute to the syndrome. The implications of the results for current treatment approaches and conceptualizations of bulimia are discussed.

Weight Control During the Holidays: Highly Consistent Self-Monitoring as a Potentially Useful Coping Mechanism

The study examined the extent to which trait self-monitoring (the systematic observation and recording of target behaviors) was related to weight control during the high-risk holiday season. The participants (32 women, 6 men) averaged 223.1 lbs (101.41 kg), 57.2% overweight, 50.2 weeks of participation, and 21.3 lbs (9.68 kg) lost at the beginning of the study. Consistency of self-monitoring and weight changes were assessed for 3 holiday versus 7 nonholiday weeks. Analyses of variance (Consistency of Self-Monitoring Groups x Holiday/Nonholiday Weeks) revealed that participants gained 500% more weight per week during holiday compared with nonholiday weeks. Only participants in the most consistent self-monitoring quartile averaged any weight loss over the 10 weeks of the study and during the holiday weeks.

Self-regulatory failure: A review with clinical implications

Abstract Empirical evaluations of therapies designed to improve self-regulatory skills have not as yet demonstrated their success as methods of ensuring long-lasting behavior change. The clinical use of concepts and procedures derived more from assumptions about the nature of self-regulation than from empirical evidence may be responsible for some of these outcomes. This paper demonstrates that a fine-grained, empirically-based, analysis of the active elements of “self-regulatory failure” is both possible and useful. Based on an examination of three literatures (successful vs. unsuccessful self-regulation; the relapse process; attention in self-regulation), eight components of self-regulatory failure are identified: depressogenic cognitions; difficulties coping with emotional Stressors; disengagement from habit change; social pressure; initial relapse episode; physiological pressure; problematic attentional focusing; and disengagement from self-monitoring. It is noted that further empirical work is necessary to specify probable patterns of interaction between these elements. One exception is discussed: it appears that many of the proposed elements can lead to disengagement of self-monitoring which, in turn, often precipitates a rapid failure to sustain effective self-regulation. Finally, a general strategy to prevent self-regulatory failure is discussed that accords well with this conceptualization—engaging in “obsessive-compulsive self-regulation.”

Proximity and specificity of planning: A position paper

The results of a recent set of studies have generated some confusion about the parameters of planning. Several findings seem to suggest that relatively proximal and specific planning improves self-regulation, whereas other research seems to favor more distal and less specific planning. The relevant concepts are defined and the literature is reviewed in an attempt to begin resolving these apparent discrepancies. This analysis suggests five conclusions, in the form of potential principles of planning. First, performance feedback is probably necessary for planning to facilitate self-regulation. Second, relatively distal and moderately specific planning may prove effective in some cases because such planning regimens encourage people to pursue their goals by continually and flexibly choosing their activities (engaging in protracted choice). Third, the effectiveness of relatively distal and relatively nonspecific plans can be increased by the process of actively choosing subgoals within those plans. Fourth, highly specific and proximal planning may debilitate self-regulation in many cases because it can severely limit protracted choice. Finally, proximity and specificity of planning are continuous dimensions, the degrees of which are determined, in part, by as yet unspecified characteristics of tasks and populations.

An experimental evaluation of a school‐based program for children at risk: Wisconsin early intervention

This article describes the nature and effectiveness of Wisconsin Early Intervention (WEI), a social development program for rural elementary school children. Incorporating a social learning formulation of child and family dysfunction, program services included social skill groups and parent/teacher consultation for referred kindergarten through 4th-grade students at two schools. Services were evaluated experimentally with random assignment of 78 children from School A to Full Service (parent/teacher consultation, social skills groups) or Partial Service (parent/teacher consultation) and 49 children from School B to Partial Service or No Service conditions. Full services resulted in decreased depression relative to partial services, based on standardized interview data. However, multidimensional ratings obtained from parents, teachers, and WEI staff consistently indicated that childrens competencies and behavior, regardless of service group, improved during the course of the program. Explanations for these results and the importance of experimentally evaluating community-level interventions are discussed.

Heterogeneity of clinical presentation among obese individuals seeking treatment

This study provides a test for the assumption of psychological homogeneity among 60 individuals who sought treatment for obesity and were referred for cognitive-behavioral group treatment. Subjects were divided along the dimension of severity of psychopathology and were assessed on subjective distress, binge eating, coping ability, and a variety of historical and demographic dimensions. Twenty-three percent of the sample scored in a range indicative of significant personality disturbance on the Borderline Syndrome Index. This distressed group did not differ from the less distressed cohort in weight, but reported more extensive symptoms of psychopathology, more chaotic eating patterns, more binge eating, and evidenced less effective coping skills. These findings provide support for the importance of a thorough assessment prior to initiating treatment for obesity.

An obesity prevention pilot program for African-American mothers and daughters

Abstract This study examined the effects of an obesity prevention program on eating-related knowledge and behavior. Subjects included 24 African-American women and their preadolescent daughters living in a low-income urban housing complex. The dyads were randomly assigned to the treatment or control group. The 6-week treatment addressed the identification of high- and low-fat foods, how to read food labels and calculate percentage of fat in calories in food, risks of high-fat eating, low-fat food planning and preparation, and the problems associated with obesity in general and within the African-American community in particular. Pre- and post-treatment measures included assessment of nutrition knowledge, nutrition attitudes, and food intake. Results showed that the treatment group, compared to controls, decreased their intake of fat in grams and in percentage of total calories. Additionally, differences within dyads showed that the mothers significantly improved their eating patterns (fat gram and fat percentage intake), more so than the daughters. A significant increase over time in nutrition knowledge was noted for the treatment group. Furthermore, although not significant, a trend for a greater increase in knowledge for the treatment group, as compared to the control group, was observed. These preliminary findings support the importance and effectiveness of parent-child prevention programs in high-risk communities.